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8. Opportunistic pneumonias
• Infections that affect
immunosuppressed patients
• Associated disorders:
– AIDS
– Iatrogenic
• Cancer patients
• Transplant recipients
Aspergillus
Pneumocystis carinii
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Cytomegalovirus
9. Chronic obstructive pulmonary disease (COPD)
Chronic bronchitis
• Definition
– Persistent cough with sputum
production for:
– at least 3 months,
– in at least 2 consecutive years.
• Pathology
– Inflammation of airways
– Hyperplasia of mucous producing
cells
– Squamous metaplasia
– Injury to cilia
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10. Chronic obstructive pulmonary disease (COPD)
Emphysema
• Destructive enlargement of
airspaces distal to terminal
bronchioles
• Two main types
Normal acinar
unit
Centriacinar
emphysema
– Centriacinar
• Destruction of central portion
with sparing of distal airways
• Upper lobes > lower
• Cause: smoking
– Panacinar
• Unform injury
• Lower lobes > upper
• Cause: alpha-1-antitrypsin
deficiency
Panacinar
emphysema
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Neutrophils
Alpha-1-AT
11. Bronchiectasis
• Dilatation of bronchi
and bronchioles
secondary to chronic
inflammation
• Associated conditions
–
–
–
–
Obstruction
Cystic fibrosis
Immotile cilia syndromes
Necrotizing pneumonia
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12. Bronchial Asthma
• Chronic inflammatory disorder of the airways resulting
in contraction of bronchial muscle
• Types
– Extrinsic (atopic, allergic).
• Allergens: food, pollen, dust, etc.
– Intrinsic (non-atopic)
• Initiated by infections, drugs, pollutants, chemical irritants
ATOPIC ASTHMA
Allergen
IgE
Mucus
secretion
Mast cell
Epithelial cell injury
Muscle
contraction
Mucus
secretion
Muscle contraction
Release of inflammatory
mediators
Recruitment of leukocytes
Acute phase
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Late-phase
13. Atelectasis
• Collapse or incomplete expansion
of part or all of the lung
• Types:
– Resorption (obstruction of airway).
– Compressive (pleural effusion or
pneumothorax)
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15. Diffuse alveolar damage
• Acute respiratory distress syndrome
(respiratory failure and arterial
hypoxemia refractory to O2 therapy).
• Basic lesions: injury to pneumocytes
and endothelial cells by:
– Oxygen-derived free radicals
– Activated neutrophils and macrophages
– Loss of surfactant.
• Etiology:
–
–
–
–
Exudative stage
Infections (viral)
Gas inhalation or liquid aspiration
Drugs, chemical, radiation
Hypotension, sepsis, trauma
• Pathology:
– Acute (exudative) stage
– Proliferative or organizing stage
Proliferative stage
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16. Pulmonary embolism
• Most emboli arise in veins from the
legs
• Large emboli (10%) are a cause of
sudden death
• Small emboli (70%) may be:
– Clinically silent
– Cause infarctions (in patients with heart
failure).
– Cause hemoptysis
• Medium sized emboli (20%)
generally cause infarctions.
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Infarct
21. Carcinoma of the Lung
• 6.5 % of all deaths
• #1 cause of cancer deaths in males & females
– 31% of male cancer deaths in 2001
• 90,367 deaths
– 25% of female cancer deaths
• 65,506 deaths
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35. Large Cell Carcinoma
• Frequency: 10 %
• Gross
– Peripheral lesion
• Microscopic
– Wastebasket group of tumors that do not fit the
criteria of a squamous cell carcinoma,
adenocarcinoma, or small cell carcinoma
• Prognosis
– Similar to adenocarcinoma
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39. 100
pa tie nts
35
ope ra ble
25-30
re se cte d for cure
8-12
survive for 5 ye a rs
( 3 0 % of those re se cte d for cure )
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40. Mesothelioma
• Mesothelioma:
– Malignant tumor of
mesothelial cells
– Highly malignant
neoplasm with short
survival
– Most patients (70%)
have an asbestos
exposure history
• Asbestos exposure
also increases the risk
of pulmonary cancer
• Smoking is not related
to mesothelioma
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41. Thank you
For more details please visit
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